Should Obama Be Fighting the Last War on Health Care? Or the Next One?

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The old rule of thumb in journalism is that it takes three to make a trend. So I think we have a trend here in the question being raised by Jonathan Cohn, E.J. Dionne, and, today, David Brooks. Brooks concludes:

The great paradox of the age is that Barack Obama, the most riveting of recent presidents, is leading us into an era of Congressional dominance. And Congressional governance is a haven for special interest pleading and venal logrolling.

When the executive branch is dominant you often get coherent proposals that may not pass. When Congress is dominant, as now, you get politically viable mishmashes that don’t necessarily make sense.

It’s also important to remember that a bill–if it passes–is only the beginning of the process. Implementing any kind of far-reaching health reform is going to take years, maybe decades. And that is an argument for making sure that it starts with both a broad base of support, as well as with its gain and pain in balance. Congress, with its two-year election cycles, is not exactly known for taking the long view. As Cohn notes, in looking at where the Senate Finance Committee appears to be headed:

Consider the proposed reduction in subsidies. In the original schemes, families of four making up to $88,000 a year would get at least some assistance; under the alternatives under discussion, only families making up to $66,000 could get subsidies. Yet families making between $66,000 and $88,000 are precisely the sort of families who could use help–not a lot of help, but a little–paying for insurance. And that’s assuming subsidies really end up at $66,000. Lawmakers could easily bid the number down more before reaching a final compromise.

Put aside, for a moment, the policy merits of these moves. The politics are lousy. Obama would be in danger of producing legislation that seems to offer little up-front benefit, particularly for the electorally vital middle class. And if some of these people end up paying even modestly higher taxes to help finance reform they’re not likely to be happy about it. It’s hard to imagine such legislation provoking a backlash that could produce total repeal. It’s not so hard to imagine such legislation creating bad political feelings, the kind that linger around until the next Election Day and pave the way for legislative retrenchment later on.

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